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PHRM 865 > Exam 3 - Skin/Soft Tissue Infections > Flashcards

Exam 3 - Skin/Soft Tissue Infections Flashcards

1
Q

Most skin and soft tissue infections are caused by what bugs?

A

Beta hemolytic streptococci
or
Staphylococcus aureus

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2
Q

what does SSTI stand for

A

skin and soft tissue infections

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3
Q

what are the 3 main layers of skin

A

outer most –> inner most layers

epidermis – dermis – subcutaneous tissue

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4
Q

epidermis, dermis or subcutaneous tissue?

non-vascular layer composed of continuously dividing cells and the stratum corneum

A

epidermis

also the outermost layer

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5
Q

epidermis, dermis or subcutaneous tissue?

consists of connective tissue, blood vessels, lymphatics, sensory nerve endings, sweat and sebaceous glands, hair follicles and smooth muscle fibers

A

dermis

also layer directly beneath epidermis

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6
Q

epidermis, dermis or subcutaneous tissue?

layer of loose connective tissue primarily containing adipose cells

A

subcutaneous tissue

innermost layer

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7
Q

what is fascia and where is it located?

A

located beneath subcutaneous tissue layer – separates skin from underlying muscle
(deep fascia forms sheath that surrounds the muscle)

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8
Q

what is some important patient history info to gather about SSTIs?

A 
immune status
geographic locale
travel history
recent trauma or surgery
lifestyle
hobbies
animal exposure/bites
previous antimicrobial therapy
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9
Q

Impetigo symptoms?

A

superficial skin infecetions: maculopapular lesions with a dried, honey colored crust – usually on face around mouth

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10
Q

Impetigo:
Typically/most common form is Non_____ type
other is ______ type

A

Non-bullous type
or
Bullous

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11
Q

Impetigo
Non-Bullous type: usually what bug causes infection?
vs
Bullous type: usually what bug causes it?

A

Non-bullous – Group A strep

Bullous: MSSA

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12
Q

Risk factors for impetigo?

A 
KIDS!!
Hot/humid climates
poor hygiene/day care settings (aka kids)
crowing
malnutrition 
diabetes
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13
Q

Topical treatment for impetigo

A

Mupirocin 2% or retapamulin 1% ointments BID x5

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14
Q

Oral options for Impetigo (systemic treatment)

A 
Dicloxacillin
Erythromycin (good if PCN allergy)
Clindamycin (good if PCN allergy)
Cephalexin
Amox/Clav
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15
Q

Symptoms of Cellulitis?

A

Rapidly spreading erythema,
edema
tenderness
warmth in skin with a poorly defined border

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16
Q

common pathogenesis of cellulitis?

A

introduced to skin during trauma, lacerations, abrasions — FISSURED TOE WEBS FROM FUNGAL INFECTIONS OF FEET, cracks in dry skin

aka any cut in the skin……

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17
Q

What patients are at risk for cellulitis

A

anybody!! happens in healthy ppl because just any cut can cause this

(common in IV drug users, arterial/venous insufficiency, pts with diabetes or obesity, immunocompromised pts)

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18
Q

Erysipelas:
variant of ______ – caused by ____________
has ________ appearance; often involves the face
Only in _____ dermis and has clearly ________

A

variant of cellulitis – caused by beta hemolytic streptococci
has peau d’ orange appearance; often involves the face
Only in upper dermis and has clearly defined borders

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19
Q

most likely causative pathogens for cellulitis

A 
S. Aureus (including MRSA)
Streptococus Pyogenes (group A strep)
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20
Q

who is at hight risk for CA-MRSA with cellulitis infections

A 
recent tattooed people
inmates
injection drug users
Native American Populations
Gat men
Contact sport participants
kids
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21
Q

Patients with skin infections due to CA-MRSA often have cellulits AND ________

A

abscess/pustules

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22
Q

why does CA-MRSA cause cellulitis AND abscesses/pustules?

A

CA-MRSA has genes for PVL (a virulence factor) been associated with TISSUE NECROSIS and ABSCESS FORMATION

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23
Q

CA-MRSA with cellulitis often susceptible to what drugs

A

doxycycline
Clindamycin
SMZ-TMP

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24
Q

Treat cellulitis like it has MRSA when?

A 
in populations specified before like: recent tattooed people
inmates
injection drug users
Native American Populations
Gat men
Contact sport participants
kids

AND

if pt has an abscess!!

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25
Cellulitis Treatment: | if no abscess or if gram stain/culture is inconclusive: empiric therapy should cover what bugs?
Group A strep AND staphylcoccus aureus
26
Cellulitis Treatment: | What drugs should be used for MILD infection/no MRSA suspected
dicloxacillin | cephalexin
27
Cellulitis Treatment: | What drugs should be used for MILD infection/MRSA suspected
SMZ-TMP Clindamycin Linezolid
28
Cellulitis Treatment: | What drugs should be used for MODERATE-SEVERE infection/no MRSA suspected
Nafcillin | Cefazolin
29
Cellulitis Treatment: | What drugs should be used for MODERATE-SEVERE infection/MRSA suspected
Vanc | Linezolid
30
Cellulitis Treatment: | What drugs should be used if patient has severe PCN allergy
Clindamycin Vanc Linezolid
31
Cellulitis Treatment: | how long to treat it
minimum 5 days!!
32
Cellulitis Treatment: | DIRECTED therapy towards strep. pyogenes --- use what drug
PCN
33
Cellulitis Treatment: | DIRECTED therapy for MRSA
Vanc, Clindamycin, or SMZ-TMP
34
Cellulitis Treatment: | DIRECTED therapy for Gram - bacilli
3rd gen cephs extended spectrum PCN (piperacillin FQs
35
Cellulitis Treatment: | DIRECTEd therapy for Polymicrobial with anaerobes
``` beta lactamse inhibitor combo (pip tazo) OR 3rd gen ceph OR FQ w/ metronidazole OR Carbapenem alone....... wtffff ```
36
Necrotizing Fasciitis: | Symptoms?
INTENSE pain wooden hard systemic toxicity!!
37
Necrotizing Fasciitis: | Risk factors?
same as cellulitis!! | like any cut....
38
Necrotizing Fasciitis: | Common bugs?
Monomicrobial: group A strep (streptococcus pyogenes) Polymicrobial: Gram - bugs AND anaerobes
39
Necrotizing Fasciitis: | Treatment -- must have what two things
``` SURGICAL intervention (surgical debridment) and Broad AF spectrum drug coverage ```
40
Necrotizing Fasciitis: | Empiric Therapy?
Vanc + Pip/Tazo meropenem ceftriaxone/metronidazole fluoroquinolone/metronidazole
41
Necrotizing Fasciitis: | Directed therapy for strep pyogenes
PCN + Clindamycin (suppress toxin production)
42
Necrotizing Fasciitis: | Directed therapy for clostridium
PCN + Clindamycin (suppress toxin production)
43
Necrotizing Fasciitis: | Directed therapy for Staph Aureus?
MSSA: Nafcillin/Cefazolin MRSA: Vanc
44
what does DFI stand for
diabetic foot infection
45
why are diabetics at increased risk for DFIs??
bc neuropathy, angiopathy with ischemia, immune system defects, decreased wound healing
46
Not all diabetic ulcers/wounds are infected: to be considered infected they have to have at least __#__ signs and symptoms of inflammtion What are the signs/sypmtoms
at least 2 redness, warmth, swelling/induration tenderness or pain
47
what system is used to classify diabetic foot infections
PEDIS Grade
48
A PEDIS grade of _____ is considered mild infection seveirty
2
49
A PEDIS grade of _____ is considered moderate infection severity
3
50
A PEDIS grade of _____ is considered severe infection severity
4
51
what does SIRS stand for
Systemic inflammatory response signs
52
T or F: Abx alone are great for treating DFIs
false!! need appropriate wound care (debridement) Tight glycemic control Optimizing blood flow too
53
Difference between PEDIS Grade 2 (mild) vs PEDIS Grade 3 (moderate)?
2: local infection -- only skin/SQ tissue -- erythema is b/w 0.5 - 1.9 cm around ulcer 3: local infection -- deeper than skin and SQ tissue -- erythema is > 2 cm around ulcer BOTH DO NOT HAVE SIRS
54
what are examples of SIRS
Temperature > 38 C or < 36 C HR > 90 bpm RR > 20 breaths/min WBC > 12,000 or < 4,000
55
What criteria makes a DFI and PEDIS Grade 4/Severe?
Local infection described above + at least 2 or more SIRS!!
56
If MILD DFI: | Covering what bacteria?
beta hemolytic streptococic and Staph aureus
57
If MODERATE DFI: | Covering what bacteria?
Same as mild (beta hemolytic streptococic and Staph aureus) + consider ENTEROBACTERIACEAE
58
If SEVERE DFI: | Covering what bacteria?
Same as moderate (beta hemolytic streptococic and Staph aureus and ENTEROBACTERIACEAE) + MRSA, Pseudomonas and Anaerobes
59
want Pseduomonas coverage for DFIs when?
if pt has soaked their foot in water! | also if pt is failing therapy w/out pseudomonal coverage or if pt has SEVERE DFI
60
Duration of Therapy for DFIs: | Mild infections?
1- 2 weeks
61
Duration of Therapy for DFIs: | Moderate infections?
1 - 3 weeks
62
Duration of Therapy for DFIs: | Severe infections?
2- 4 weeks
63
Duration of Therapy for DFIs: | if bone involvement?
4 - 6 weeks
64
Empiric Therapy for DFIs: | Mild Infection?
PO Cephalexin OR PO dixcloaxillin OR PO Augmentin or PO Clindamycin or PO SMX/TMP
65
Empiric Therapy for DFIs: | Moderate infection?
IV cefazolin (IV ceftriaxone alone if enterbacteriaceae suspected) add PO metronidazole if anaerobes suspected
66
Empiric Therapy for DFIs: | Severe infection?
BROAD SPEC AS HELL: ``` VANC + Pip/Tazo or VANC + meropenem or VANC + Ceftazidime + metronidazole or VANC + Cefepime + metronidazole or VANC + FQ + metronidazole ```
67
what organisms are we trying to cover for empiric therapy of severe DFIs?
strep, staph (MSSA and MRSA), enterbacteriaceae, pseudomonas, and anaerobes....
68
Non-antibiotic options for treatment of DFIs?
appropriate wound care!! debridement/stay off it/bed rest tight glycemic control optimizing blood flow (smoking cessation/stents..)

PHRM 865 (59 decks)

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